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May 14th – 20th is Sun Awareness Week. And, although I can barely think to type over the sound of rain on the conservatory roof, it’s best to be ready for when the warmer weather finally makes an appearance!  When 86% of skin cancers are preventable it’s ludicrous that we don’ take this advice more seriously!1

Protection from the sun isn’t rocket science. Here we dispel some common myths:

It’s not even that sunny, so I don’t need to wear a sunscreen.

It doesn’t have to be a cloudless sky with scorching temperatures for our skin to be exposed to the UV light. Even on a bright but cloudy day you can still get burnt, especially when on holiday and nearer the equator where the sun’s rays are hotter.

I like to sit in the shade, so I don’t need to wear sun protection.

Most people believe that the shade will protect their skin but there are many different types of shade. The shade cast from a building for example will be ‘good’ shade providing much more protection than the dappled shade from a tree. Even sun parasols do not provide 100% UV protection, the fabrics let in a percentage of the UV rays. Even when you are sat in the shade you should still wear UV protection, and don’t forget that you may have to walk to your chosen shady spot and your skin will be exposed until you reach it.

I always wear my baseball cap, I know my head is protected.

Baseball caps provide a good protection to the top of the head and some protection to the face, but they provide no protection to the neck or ears. You are much better to choose a wide brimmed hat that will protect the ears and neck as well as head and face. A brim that angles downwards is the most effective. This is particularly important for children when they are out in the sun.

I applied my sun screen this morning, so I’m covered.

Some sunscreens now claim to only need to be applied once throughout the day, while others describe themselves as longer lasting or waterproof. Any sweating, swimming and changes in clothes or rubbing of a bag across shoulders will remove some of the UV protection. It is best to reapply your sunscreen every 2-3 hours and again after swimming or sweating to be sure you are protected

I packed a full bottle of sun lotion, me and my family are all prepared.

People often do not apply anywhere near enough to cover their skin fully. If you are applying enough you might get through a full 200mL bottle in as few as 6 full body applications. Bear this in mind when purchasing your sunscreen and stock up to ensure the whole family are protected. Also, you can’t assume you will all need the same protection. Children and people with fair skin will need a higher protection than those with a more olive or darker skin.


Thought you knew all there was to know about sun protection? These are very common misconceptions that a large proportion of people believe to be true. Now you know the facts don’t take a chance with your skin. Wear protection, find shade and cover up.


Cancer Research UK – 


Let’s face it, us blokes aren’t very good at addressing health concerns. From our perspective, we need to show we’re tough and can keep going…we don’t let ‘little’ health concerns trouble us, or at least we wouldn’t admit to it.


Nitin Makadia

And it doesn’t help that when we are unwell we must just have ‘man flu’ or that we have a lower pain threshold that stops us being able to get on with things…so, we feel we have to prove ourselves by ‘manning up’.

The serious downside to this is that we don’t often get the help that we need and, on average, live nearly 4 fewer years than women. This needs to change. It needs to change now, because…

  • 76% of suicides, that’s over 3 out of every 4, are by men
  • Suicide is the biggest cause of death in men under 35
  • Prostate cancer kills 35 men every hour
  • Testicular cancer is the most common cancer in men under 40

Today marks the start of Movember, the annual campaign to get more of us talking about men’s health and doing something about it.

The issues that Movember is targeting are:

  • Prostate Cancer
  • Testicular Cancer
  • Suicide

So, through November I shall be talking about these issues…and more. In the meantime, if you have any questions about men’s health, please free to contact me at 


An excuse to do less, or a reason to do more?

We’ll often hear from those living with arthritis…or “suffering” as they will more likely describe it…about what they can no longer do. The pain and stiffness is now a limiting factor and our body’s way of telling us to slow down.

Nitin Makadia

And with new stories always telling us that painkillers are either ineffective, bad for our heart or addictive, it’s understandable we will want to avoid them…but perhaps not tell the doctor!

Sometimes though, I hear the opposite. Someone who will take the full dose (& sometimes more!) of all of their pain medicines just so they can keep going with their busy life…fighting through the pain…it’s not going to defeat them!

Arthritis Research UK are taking a pro-active approach with their ‘Share your Everyday’ campaign, enabling those living with arthritis to share their experiences to allow people to learn from each other: ShareYourEveryday

Just one example of something that can make a huge difference is pacing…doing things steadily over the day and taking time to relax in between.

  • Doing as much as possible as quickly as possible before the pain becomes unbearable will mean getting less done overall, with a heavy reliance on painkillers that should be kept aside for occasional breakthrough pain
  • Putting the brakes on life and doing as little as possible to remain as pain-free as possible will further stiffen the joints, is bad for overall health and the weight gain from inactivity will put more pressure on the back and joints, not to mention leading to a poorer quality of life

But pacing is just one piece of advice out of many. Every individual is different, and of course there are many forms of arthritis that need a tailored approach.

Pharmacists have the most frequent contact with their patients and are therefore perfectly placed to make brief interventions each time. This can be initiated whilst conducting Medicines Use Reviews when there would be the perfect opportunity to open up a conversation, dispelling myths around treatments, addressing concerns around opioid analgesic dependence (& referring where appropriate) and offering lifestyle advice after first listening and understanding…particularly important otherwise we risk giving the right solution to the wrong problem by being efficient instead of effective.

And pharmacists themselves need support…education in the non-medical interventions they can suggest…time to have the conversations…tools to support those conversations. A service I was involved with demonstrated the significant improvement in quality of life that can be achieved…but it needs vision and leadership…and of course funding from commissioners or Pharma partners. But the reward in what we can achieve for our patients reminds us why we are in healthcare.

Those living with arthritis are not looking for an excuse to do less, but without support they won’t know they can, and should, do more.

Evolve Health Solutions can support pharmacists to engage with their pain customers, with appropriate training, support materials, tools and outcome measures. Contact us for more information at


I don’t have high blood pressure!

…at least I don’t think I do?

Monday 12th September marks the start of Blood Pressure UK’s Know Your Numbers week, and there’s a very important message here for us all.

Nitin Makadia

“Ahhh…but I don’t have high blood pressure, so there’s no point in me reading on”

In fact, those who don’t have, or assume they don’t have, high blood pressure probably have the most to learn. And this isn’t just a message for the individual…think about those around you – your family and friends, or those who work with you…or for you. Any one of these people might have high blood pressure without knowing it, so it’s important to spread the message and encourage them to find out, or arrange screening at your office or place of work. Because unless you actually “know your numbers”, you won’t really know if you have high blood pressure.

“Yes, yes, I get it…but I feel great and have no symptoms”

High blood pressure often has no symptoms, you may feel perfectly fine…that’s why it’s called the ‘silent killer’. Yes, it’s a juggling act giving your best at work and enjoying life when you can. Work hard, play hard. OK, perhaps you don’t eat as well as you should, and don’t get a chance to just unwind and relax or to exercise as much as you’d like to. But your body hasn’t started to ring any alarm bells yet so there’s nothing to worry about, right?

You’re probably right…probably.

But in an extended family, in a big group of friends, in your team at work…the odds against all those ‘probablies’ start to add up. Somebody WILL have high blood pressure and not yet know it. It could even be you.

“Well, if I do have high blood pressure I still feel perfectly fine so the last thing I want is to start taking medicines for the rest of my life…so I’d rather not know!”

It’s not necessarily about taking medicines. In fact the great thing about knowing your numbers is you pick things up early…early enough that you can make the lifestyle changes to get it back under control BEFORE it gets to the stage where you need to start taking medicines.

And if you do need to take medicines it’s about understanding why they’re important in keeping blood pressure under control. High blood pressure exerts damaging pressures on different part of your body, leading to increased risk of heart attacks, heart failure, stroke, kidney disease, peripheral vascular disease…all of which lead to a significant deterioration in your quality of life. So if you’re at all unsure about taking blood pressure medicines, or have decided yourself to not take the full dose, talk to your pharmacist to get a better understanding.

You wouldn’t neglect your car…so why neglect your own health?

Just like your body, you put your car through a tough time. But once a year you take it to a trusted garage to get it serviced and checked for hidden problems. And, in between, you have warning lights that come on if things aren’t quite right. So when’s the last time you looked after your own health that well?

Unfortunately, we don’t have warning lights. And if we wait for symptoms to appear, chances are that there has already been some damage which can’t be repaired, although not too late to stop it getting worse. So now is the time to act:

Click here to visit Blood Pressure UK’s website to find your nearest Pressure Station. And if you’re a business that wants to look after its staff, contact Evolve Health Solutions to discuss how we can help.


Chronic Pain: Managing the burden

With a recent BMJ publication[1] suggesting nearly 28m people living with chronic pain in the UK, how can our healthcare system possibly cope with these numbers and give those living with pain the quality of life they deserve?

Nitin Makadia

Pain has a significant impact on…

  • the ‘normal’ lifestyle of those living with it
  • the UK economy’s productivity through sickness absence and permanent withdrawal of skilled employees from the workforce
  • both the NHS and Social Care budget and manpower resource

So, we have significant numbers of people whose pain remains uncontrolled because they don’t have ready access to, and information from, the overstretched healthcare professionals they would normally expect to rely on.

The role of community pharmacy

So whilst the Government ponders on its plans to further devastate community pharmacy, this would be a great time to remind them how pharmacists can make a difference:

  • Treating those with acute pain appropriately so that it doesn’t develop into chronic pain
  • Supporting those on prescribed chronic pain medicines to better manage their treatments through medicine reviews
  • Providing holistic help, advise and signposting to make lifestyle changes that positively improve quality of life

With pain consultations taking up 20% of GP appointments at a cost of £650m/year[2], this would free them up to focus on those patients with more complex needs, or to quickly see those referred from the pharmacy.

GPs would also have more time to spend with patients and reduce the bounce rate into secondary care

Is this realistic?

The size of the problem is huge…but so too is the size of the opportunity…the rewards to both patients and all areas of the health service. What it needs, however, is a change in behaviours of all those involved:

Pharmacists need to set themselves up with a consistent service to offer to their patients…& they also need to shout about it, or no-one will know. They need to talk to their GP practices to support 2-way referral, & agree the criteria for referral.

GP Practices need to work collaboratively with pharmacists and actively refer patients seeking to make a GP appointment. This may be difficult where patients don’t wish to disclose the reason for their appointment with reception staff, but there are enough other signposting opportunities through posters and electronic surgery messaging.

Pharma needs to support community pharmacy to trial such services to demonstrate health outcomes to NHS commissioners as well as internal business models which show the returns on investment from medicine reviews, improved adherence and OTC sales

Employers need to invest in the Health & Wellbeing of their staff beyond just adjusting the working environment to minimise accident and injury…such as supporting those with chronic pain or any long term conditions to better manage their condition and therefore remain more productive at work.

And finally, NHS paymasters need to put their money where their mouth is. Whilst there is a ‘crisis’ in adequately training and recruiting other healthcare professionals, there is an over-supply of clinically skilled pharmacists coming through an increased number of UK Universities. It is unsustainable to keep cutting funding and expecting pharmacists to earn this back by doing even more…and the fact that there are more pharmacists means the funding is just being diluted…pharmacy needs MORE funding and closer integration into primary care!

  1. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies:
  2. Phillips CJ. Economic burden of chronic pain. Expert review of Pharmacoeconomics & Outcomes Research 2006;6(5): 591-601

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